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In 1931 a Chicago paediatrician Joseph Brenneman wrote “there is a menace in psychologizing the school child, psychiatrizing his behavior and overorganizing his habits and his play”.1 He attacked the psychologists of the day for interfering with the innocence of childhood. “What I do object to … is the unwarranted psychiatric injection of sex into child life”.2 Paediatricians could manage the problems of childhood without this kind of nonsense. A decade later the child psychiatrist Leo Kanner, who had already pioneered a joint clinic with a paediatrician at Johns Hopkins Hospital, noted that there was “a tendency to ridicule and resent any psychiatric offerings”.3 Citing Brenneman, later American psychiatrists4 5 have written about their relationship to paediatrics. The theme is familiar: paediatricians are frustrated — even irritated — by child psychiatrists, who seem to live in a world of their own, on a different timescale, speaking a mystifying language.
THE CULTURAL GAP
Much has been learned since those days, on both sides of the Atlantic. The pioneering work of many paediatricians, psychiatrists, psychologists, psychotherapists, nurses and social workers has changed the landscape, yet the geology beneath still bears separate strata for medicine and mental health. Although ambivalence is now more muted, the marginalisation of mental health in hospital paediatrics continues into the present century. This is partly due to the fact that mental health provision for some paediatric departments remains uncoordinated, confusing or inaccessible. Even in London, where some richness of resources might be expected, only a minority of departments has a dedicated liaison service.6 Despite a strong desire from the vast majority of paediatricians for more, most of them have not had a satisfactory experience of it. This is a bind. Unless they have worked with responsive and effective liaison colleagues, paediatricians are in no position to …
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